Source:  Mr. Willie Ermine, M. Ed, Assistant Professor, First Nations University. A member of the Sturgeon Lake First Nation in the north-central part of Saskatchewan, he has worked extensively with Elders, promotes ethical practices of research involving Indigenous Peoples and is particularly interested in the conceptual development of the ‘ethical space’–a theoretical space between cultures and worldviews.

This paper will examine some of the benefits of traditional healing and medicines with tentative possibilities entertained. It will also briefly look at the nature of traditional medicines and healing traditions, examine the reflective space in which a dialogue can ensue, and provide a surface discussion of a few possibilities with respect to the calls by the Truth and Reconciliation Commission of 2015.  

“We call upon those who can effect change within the Canadian health-care system
to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients
in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.” (TRC, 2015)

 
The above Call to Action by the Truth and Reconciliation Commission (2015) presents intriguing possibilities for positive change in the healthcare landscape for Aboriginal people. The possibility presented is that Indigenous and Western knowledge systems can co-exist and harmonize treatment resources, and that this pluralism expands opportunities for effective mediation of sickness and disease and related traumas. This idea also offers an opportunity for the exchange of critical knowledge that can lead to opportunities of innovation, informed policy, and to advocate for greater recognition for the role of traditional medicines, where and when they fit best alongside western medical practices, and vice versa. Such collaboration would enable the visionary elements of a harmonized health care system that can start to create parity in health care for Aboriginal users. We will examine herein some of the benefits of traditional healing and medicines and the tentative possibilities of health that protracted cooperation between knowledge systems can create. With this in mind, we will also briefly look at the nature of traditional medicines, examine the reflective space in which a dialogue can ensue, and provide a surface discussion of harmonization possibilities as called for by the Truth and Reconciliation Commission of 2015.     

 
Background

In 2009, an international collaborative research proposal was submitted to the three health funding councils of Canada, Australia, and New Zealand. The “International Collaborative Indigenous Health Research Partnership Grant” proposed research towards reducing the burden of disease and inequalities for Indigenous peoples through collaborative efforts between Indigenous healing and Western medical practices. The funding for such a project was tethered to the approval of the respective proposals in all three countries. The unwelcome news is that unanimous approval in all three countries did not happen, and the ambitious research projects never saw the light of day. The good news, however, is that the Canadian research team’s proposal was approved by the Canadian Institutes of Health Research, indicating a general measure of willingness for innovation in the Canadian healthcare system.

The general intent of the Canadian research proposal was to identify where and when traditional medicines and practices fit best alongside Western medical practices in the management of sickness and disease for Indigenous peoples. The idea was to bring Indigenous healers and Western medical practitioners to meet and exchange critical knowledge for the greater recognition of the role traditional medicine and practices can play in contributing to the well-being of Indigenous populations. The visionary appeal of the Canadian proposal was to identify innovation and cooperation in health care, which could lead to the development of a framework for harmonizing traditional medicines and practices with the established organisation of the Western medical system. The Canadian research proposal was built on the assumption that Indigenous and Western knowledge systems of health already co-existed, and that greater recognition of this medical pluralism could expand opportunities for effective disease management and prevention, particularly in Indigenous populations.

Traditional Medicine

The World Health Organization defines traditional medicines as, ‘the sum total of knowledge, skills and practices based on the theories, belief and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illness.’ Despite the oppression and suppression that Indigenous peoples experienced through the past, and claims that such healing practices were no longer in use, substantial evidence exists of the knowledge and continued practices of healing with the benefits of associated Indigenous pharmacopeia.  Indigenous healing and its cultural foundations are part of recognized Aboriginal Rights in this country and, as such, need to be defined solely by the Indigenous knowledge base composed of its epistemology, philosophy, and spiritual worldview. The protocols of Indigenous healing and associated knowledge have always guided the work of Indigenous healers and pharmacopeia specialists through many generations.  Implicit with these rights and practices is the requirement for self-determination and the protection of that autonomy in cross-cultural contexts. Indeed, traditional medicine practices have continued despite policies, and are used in contemporary contexts in assisting individuals and communities to address the legacy of historical trauma as well as the emergence of sickness and disease.

In Canada, there has not been an overarching policy on traditional medicine. That no national policy exists results in a patchwork of existing practices, with some provinces and territories remaining silent or endorsing the use of traditional medicines and role of Aboriginal healers. For example, Ontario has some provisions for traditional healers[1] and midwives[2] to continue practice without fear of prosecution. In Manitoba, a provincial government report expressed the importance of traditional Aboriginal healers and has indeed implemented a functioning and effective traditional health system through the Winnipeg Regional Health Authority.[3] Alternatively, where no such guidance exists, there are promotional claims that existing health services have models of care that are ’patient-centered.’ As affirming as these statements might be for expansive and focused care, culture has always been notably absent in the services afforded to Aboriginal patients. The Indigenous worldview is said to be “holistic,” by encompassing all aspects of life: the physical, mental, emotional and spiritual.[4] The holistic perspective informs Indigenous values and ways of being, including a conscious and harmonious relationship with the natural and spiritual environments articulated and expressed through culture. This holistic theory continues to be the foundation of Indigenous healing. Within Western paradigms of healthcare, the concept of patient activation from an Indigenous or cross-cultural perspective, where patients can take a measure of ownership of their continued health is not fully addressed. Embedded in local traditions, traditional healing/medicine practices offer culturally consistent and appropriate care, thereby increasing acceptability and service responsiveness.

 
Ethical Space

Ethical Space[5] is a theory that has been proposed to frame the respective encounters between knowledge systems and proponents alike. Collaboration between Indigenous healing systems and Western medical processes will require a place of reflection and dialogue that is safe and inclusive while invigorating honest exchange and partnership. The framework provided by the theory of ethical space is seen through the analogy of a space between two entities, such as the space between the individuals and in the time-lagged void between Indigenous and Western knowledge worlds. The space is initially conceptualized by acknowledging diversity between human communities and unwavering constructs of difference between peoples’ worldviews as highlighted by distinct histories, knowledge traditions, philosophies, and social, political and economic realities. Western medical practice, with its flagship enterprise of Western science, has been variously described as reductionist, linear, objective, hierarchal, empirical, static, temporal, singular, specialized, and written.[6] By contrast, the Indigenous worldview as stated above, encompasses so much more.

Recognizing that the Indigenous-Western encounter is about thought worlds reminds us that frameworks or paradigms are required to reconcile these solitudes in the interest of mutual understanding. The proposed framework builds on the assumption that Indigenous and western knowledge systems exist simultaneously, and that the affirmation of this knowledge pluralism expands opportunities to develop effective strategies for health care and its maintenance. The creation of the ethical space paradigm in health delivery is one whose time has come. In the words of Naisbitt (1982), “those who are willing to handle the ambiguity of this in between period and to anticipate the new era will be a quantum leap ahead of those who hold on to the past.”[7] It is anticipated that a new alignment built on partnership will create new currents of thought that flow in different directions and overrun the old ways of thinking.

 
Relationships

Ethical space reminds us of the unseen but influential nature of the forces we bring to our encounters with each other. The human-to-human interface of our encounters are composed of decision points and actions that summarily create our human experience, particularly in cross-cultural contexts. From Indigenous perspectives, health and relationships are thought of in ways that go beyond the physical encounter to include the other dimensions of our being such as our sensibilities, mind, and spirit. This holistic way of looking at healthiness and interaction is acknowledged in the practices of traditional healers. There are relatively few processes in the Western biomedical model that take care of spiritual wounds for example or how matters of the mind such as stress could affect the condition of the heart.[8] The healer’s art is to simultaneously entertain the inner spiritual world, emotions, mental states, along with the physical condition of a person.

Dialogue and cooperation between knowledge systems need to be grounded to human experience in the sense that the participants must speak from the heart or as autonomous actors in the universe with unscripted thoughts and feelings. Harwood and Creighton (2009) suggest in their report The Organization-First Approach to “promote the practices that enable citizens to act together effectively – that is, to engage one another rather than just be engaged by institutions.” [9] This is to recognize that the inertia of health institutionalisation has appropriated our human freedom to intend the future of our healthcare and to speak to each other from our real selves about our dreams of healthiness. Not all health knowledge necessarily resides in Western institutions or systems. Empowering Western health systems with inclusivity involves protracted efforts of dialogue and sensitivity to the holistic dimensions of Indigenous health practice.

This often involves taking risks with new and innovative programming that is relevant to the Indigenous community but may cause anxieties for mainstream agencies. These resourceful programs that are created “outside the box” have often become models. Indeed, it is through this process of risk taking that the creation of new health delivery models becomes possible.

 
Indigenous Art of Healing

Indigenous traditional medicine practitioners have been variously identified as spiritualists, herbalists, diagnostic specialists, medicine men/women, healers, and midwives.[10] These are the specialists in field of Indigenous healing and traditional medicines with each performing their service independently. Traditional healers are herbalists or medicine persons who “know medicine well," or "ones who use medicine for healing purposes." These Indigenous practitioners not only have knowledge of plants and their properties as well as the methods of preparing and administering them to patients, but are also gifted in their own right with sensibilities to work as healers. The art of the healer includes healing methods such as the use of herbal medicines and other spiritual observances including cleansing of mind spirit and body and often with the use of the sweat lodge or other ceremonial practices. Indeed, the healer’s work is supported by the ceremonial traditions where, depending on the diagnosis, treatments can range from the application of roots and herbs to spiritual intervention, community-wide ritual, and ceremony. This tradition of the healer has never been abandoned. Significantly, the healer’s art includes encouraging and enabling patients to take ownership and a degree of control of their own health and remedy with active participation. This involves patients to “story” their condition and the Healer’s counsel on the personal ritual that must accompany the herbal treatment. The healer’s art enables wellness to become a spiritual journey, for patients to enter into newness – new understandings, new awareness, and new ways of being through traditional teachings of wholeness and healthiness.

 
Innovation in Health Care Delivery

One feature of health care delivery in the Indigenous community is the emergence of the traditional health clinic, where patients have access to traditional healers and other alternative therapies. It is a forum where patients can sit in consultation with traditional healers, and therapies, most often in the form of traditional medicines, are prescribed by practitioners. Helpers and apprentices assemble the prescribed medicines taken from the Indigenous pharmacopeia, or the “medicine room.” This community practice has been an innovative creation in the Manitoba experience of traditional and western collaboration. In this instance, there are traditional health clinics with the use of traditional medicines conducted by a traditional healer in the Winnipeg General Hospital (K. Bird, 2022, personal communications).  In the Manitoba model, space is provided for the healer along with a “medicine room” where the healer keeps the array of Indigenous pharmacopeia for use during the clinics. The space also lends itself to procedures requiring medical smudging of patients for conditions such as mental anguish, emotional distress, or the spiritual cleansing that goes with traditional health practice. Contracting of the healers through the Health Authority covers the costs of apprentices and medicinal harvesting besides all the administrative and logistical exigencies that go with the services within the hospital.

The Manitoba experience and model of inclusive healthcare, as a feature of traditional and Western health collaboration, reminds us that there are possibilities of affirmed healthcare and harmonization of practices where none have existed before. The road to harmonization takes into consideration a referral system, for example, that goes both ways. With the model of harmonization adopted by the Winnipeg Regional Health Authority, there is a system of continuing referrals between Western doctors and Indigenous healers for the holistic care of patients. The organized practice encourages referrals at the critical decision points about the health status of patients. Mutual respect for one another’s practice is one of the guiding principles of such collaboration and balance is achieved by not discouraging patients from consulting any one system for their medical needs. Mutual respect for each other’s knowledge and methods is a requirement under this system. Indigenous healers understand that traditional medicines can be directed to work in harmony with Western medications and that the two prescriptions should not be subjected to competition. Indeed, Indigenous healers working from a spiritual grounding can also recognize the spirit of Western medicine. Reciprocally, in the Manitoba experience, doctors working with addicted patients have made referrals to Indigenous healers for patients to go on traditional liver cleansers as part of their treatment to extricate residual toxins from the body.

Healthcare is a concept with practices that respond to the debilitating nature of sickness and disease and associated trauma. It is at the point of urgent need by a patient, at their most vulnerable, that medical treatment should be at the ready and at its finest. For Aboriginal patients, as others, these points of urgent need are usually experienced in the intensive care units of hospitals, and at times in lonely anguish without family and other supports. Without the recognition of unique Aboriginal needs nor Aboriginal healing resources, many patients may be denied very crucial service involving traditional medicines at these critical stages when, indeed, all possible resources should be made available. A harmonized system of care involving traditional health practices and Western medical resources would enable continuing care at all levels and stages patients are experiencing.

Another possibility of collaboration between Western and Indigenous health approaches is within the area of diagnostics. For Indigenous healers, the range of interaction required with patients is an important consideration because of the expansive nature of diagnosis at the emotional, physical, mental, and spiritual levels. This feature of the healer’s method is significantly different than the Western physician’s practice, but one that ensures that the practice of traditional medicine acknowledges the ongoing healing journey of an individual to acquire restoration and balance. 

The cooperative roads might also lead directly to Indigenous communities where the Western medical practitioners can be variously engaged to support community health traditions in the treatment of sickness and disease for Aboriginal people. Physicians and other specialists have indeed taken part in community sweat lodge ceremonies, and many are aware of the availability of indigenous healing resources. Whether in hospital settings or community contexts, one of the recent and promising recognitions is the role of an Aboriginal liaison/navigator to help steer the cooperative spirit between the West and the Indigenous. An aboriginal liaison or navigator is a competent mediator of cross-cultural interaction with a sensibility to the ways of ethical engagement between contrasting cultures or worldviews. In Cree society, this navigator, or servant of the people is better known as the “Oskapiwis.” Workers that can navigate the contours of Indigenous knowledge and have the skill set to work with Elders and knowledge keepers, while possessing the capacity to operate in the Western world, have significant roles to play in the creation of new and relevant health programming for Aboriginal users.

The cooperation between the traditional and bio-medical models of health is captured in the Cree First Nations term mâmawôhkamâtowin, that talks about putting energies together and doing things together for a common cause. There are various dimensions to the idea of mâmawôhkamâtowin. For example, consensus is the agreement of the collective, or a shared consciousness about the need to do things that really matter to people. The collective effort is to recognize that individuals or mono cultural systems have limitations in what they can accomplish and that the pooled energy of working together takes them beyond individual constraints and thresholds. Such collaboration would enable the visionary elements of a harmonized health care system that starts to create parity in health care for Aboriginal users.

Thus, in examining some of the benefits of traditional healing and medicines as well as the reflective space in which dialogue can ensue, and by providing further discussion of some of the possibilities with respect to the calls by the Truth and Reconciliation Commission of 2015, this paper surmises that it would be conceivable to develop a model for a harmonized, collective system that would encompass the different styles of medicine in a complementary and collaborative fashion.  

[1] Ontario. Regulated Health Professions Act. 1991. 2022

[2] Ontario. Midwifery Act. 1991. 2022

[3] Manitoba. Health Choices: What Manitobans Said: Final Report. 2002. 2022

[4] Benton-Benai E. 1988. The Mishomis Book. Hayward, Wisconsin: Indian country Communications Inc.

[5] Ermine W. Ermine, W. (2007). The Ethical Space of Engagement. In Indigenous Law Journal. Vol. 6:1. Pp193-

[6] Smylie J. Martin C.M. Kaplan-Myrth N. Steele L. Tait C. Hogg W. 2003. Knowledge translation and indigenous knowledge. Circumpolar Health. Nuuk.

[7] Denzin N. Lincoln Y. Handbook of Qualitative Research. 2000. Thousand Oakes: Sage

[8] Robertson P. Collaborative Organizing: an “ideal type” for a new paradigm. In Research in Organizational Change and Development. 1999. Greenwich, Conn.: JAI Press.

[9] Harwood, R. C., & Creighton, J. A. (2009). The organization-first approach: how programs crowd out communities. Bethesda, MD: The Harwood Institute for Public Innovation.

[10] Martin Hill, Dawn. 2003. Traditional Medicine in Contemporary Contexts: Protecting and Respecting Indigenous Knowledge and Medicine. National Aboriginal Health Organization. March, 2003.